This study aims to determine possible associations between strength parameters, injury rates, and performance outcomes over six seasons in professional basketball settings. Thirty-six male professional basketball players [mean ± standard deviation : age, 30.5 ± 4.7 years; height, 199.5 ± 9.5 cm; body mass, 97.9 ± 12.9 kg; BMI 24.6 ± 2.5 kg/m2] participated in this retrospective observational study, conducted from the 2008–09 to the 2013–14 season. According to their epidemiological records, each player followed an individual plan designed within (...) different strength training programs: Functional, Eccentric, or Resistance. Seven hundred and fourteen valid records were obtained from 170 individual strength tests during 31 sessions. Tests performed were leg press, squat, and jerk. Parameters recorded were force, power, velocity, peak velocity, and time to peak velocity for strength; time loss injury and muscle injury for injury rate; and games won, games lost, and championships for performance outcomes. All the strength variables and injuries are independent of the strength programs. The correlation analysis showed very significant relationships between muscular injuries and time to peak velocity, significant relationships between force and games lost, and muscular injuries with games lost per season. Mean values per season described a possible association of force, time to peak velocity, and muscular injuries with performance outcomes. In this specific context, strength variables and injury rate data show no association with a single type of strength training program in this cohort of high-performance basketball players. (shrink)

Rape conviction rates have fallen to all-time lows in recent years, prompting governments to explore a range of strategies to improve them. This paper argues that, while the current legal impunity for rape cannot be condoned, increasing conviction rates is not in itself a valid objective of law reform. The paper problematises the measure of rape law that conviction rates provide by developing an account of (some) feminist aims for rape law reform. Three feminist aims and associated measures are explained—all (...) of which look beyond conviction rates to qualitative and victim-centred outcomes of criminal justice processes. Applying these measures, I argue that strategies designed solely to increase conviction rates are more likely to work against, rather than in support of, feminist aims. The paper thus underscores the need for continued feminist engagement with rape law reform, broadly conceived, notwithstanding its acute limitations for feminist anti-violence politics. (shrink)

The relevance of Marx’s theory of value and his ‘law of the tendency of the rate of profit to fall’ to the analysis of the financial crisis of 2007–8 and the ensuing global slump is affirmed. The hypertrophic growth of unproductive constant capital, including the wages of ‘socially necessary’ unproductive labour and tax revenues, is identified as an important manifestation of an historical-structural crisis of capitalism, alongside the increasing weight of fictitious capital and the proliferation of fictitious profits (...) in the lead-up to the financial crisis. These phenomena have obscured the deepest roots of the global slump in the long-term profitability problems of productive capital – that is, in a crisis of surplus-value production. With these considerations taken into account, a better empirical assessment of trends in the composition of capital becomes possible, and with it a more accurate understanding of the impact of the ongoing displacement of living labour from production on the average rate of profit and the future of US and global capitalism. (shrink)

Rates of deceased organ donation in the UK fall well short of those reported from other parts of the world, and result in unnecessary deaths and avoidable morbidity. A particular feature of the UK problem is that its total potential for donation is lower than the actual number of donors reported in the highest-donating countries. This implies that while the identification, referral and conversion of recognized potential deceased donors is an important component of any strategic effort to increase donation, (...) more fundamental is an understanding of why some countries have a greater potential for donation, particularly donation after brain death. While it is possible that these differences reflect a difference in the incidence catastrophic brain injury or the outcomes from it, it is also possible that it reflects different approaches to the care that such patients receive when they are dying. (shrink)

Background: Benzodiazepines have been widely used in clinical practice for over four decades and continue to be one of the most consumed and highly prescribed class of drugs available in the treatment of anxiety, depression, and insomnia. The literature indicates that Benzodiazepine users at a significantly increased risk of Motor Vehicle accidents compared to non-users but the impact on injuries at workplace is not well-defined. We aimed to investigate whether use of benzodiazepine is associated with increased risk of occupational injuries.Methods: (...) PubMed, Embase, and Scopus databases were searched. A meta-analysis was performed to calculate odds ratio and 95% confidence interval among case controls, cross-sectional studies, either questionnaire or laboratory exams based.Results: A total of 13 studies met inclusion criteria, involving 324,168 OI from seven different countries, with an estimated occurrence of benzodiazepine positivity of 2.71%. A total of 14 estimates were retrieved. Of them, 10 were based on laboratory analyses, three on institutional databases, while one study was based on questionnaires. Regarding the occupational groups, three estimates focused on commercial drivers, that exhibited a reduced risk ratio for benzodiazepine positivity compared to other occupational groups. Eventually, no increased risk for benzodiazepine positivity was identified, either from case control studies, or cross sectional studies, when only laboratory based estimates were taken in account.Conclusions: Even though benzodiazepines have the potential to increase injury rates among casual and chronic users, available evidence are insufficient to sustain this hypothesis, particularly when focusing on laboratory-based studies. (shrink)

Since the collapse of the bubble economy at the beginning of the 1990s, Japan has been in secular stagnation. Despite the stagnant economic conditions, the rate of profit has been rising, not falling. The coexistence of the rise in profitability and prolonged economic stagnation is a manifestation of the fundamental contradiction of present-day Japanese capitalism. Marx’s law of the tendency of the rate of profit to fall (LTRPF) provides a consistent explanation regarding the paradoxical situation in Japan (...) characterised not by a falling but a rising rate of profit. Meanwhile, this paper discusses the Monopoly Capitalism school, which has studied capitalist behaviour concerning productive investment and changes in the form of capitalist competition at the monopoly stage of capitalism. While the school’s negation of the LTRPF is unacceptable, their notions may provide useful explanations as to why the rate of profit has risen under secular stagnation in Japan. (shrink)

This article examines two views about the capitalism that lies at the heart of modern industrial society. We owe to Marx and Piketty two large-scale, hugely important, but very different studies of the nature of modern industrial capitalism. In Capital, Marx provides a complex analysis of the anatomy of modern industrial capitalism, which he regards not as stable but rather as over time unstable and tending toward internal collapse on several grounds, of which the most important is apparently the so-called (...) tendency of the falling rate of profit. The falling rate of profit supposedly threatens its continued existence. Piketty criticizes the latter view in the context of his theory of contemporary capitalism. The article suggests, first, that Marx's view of the falling rate of interest is empirically implausible but Piketty's rival claim is empirically plausible. Second, a successful transition from capitalism to communism on Marxian grounds is unlikely in practice. And finally, despite Marx's intentions, it is unlikely to realize itself in practice, and is in this respect a traditional theory. (shrink)

A number of studies have investigated and found a significant relationship among economic wealth, Hofstede’s national culture dimensions, and software piracy rates (SPR). No study, however, has examined the relationship between economic wealth, culture, and the fact that national SPRs have been declining steadily since 1994. Using a larger sample than has previously been available (57 countries), we confirm the expected negative relationship between economic wealth, culture (individualism and masculinity) and levels of software piracy. The rate of decline in (...) software piracy, however, is found to be a cultural phenomenon, with two factors (power distance (PDI) and uncertainty avoidance (UAI)) working in opposition. Similar results are found for a subset of 37 relatively poor countries. This suggests that, while the rise in economic wealth seen for most countries should lead to a reduction in software piracy, the rate of decline is determined by cultural factors. Global strategies for dealing with software piracy are discussed. (shrink)

The essay is framed by conflict between Christianity and Darwinian science over the history of the world and the nature of human personhood. Evolutionary science narrates a long prehuman geological and biological history filled with vast amounts, kinds, and distributions of apparently random brutal and pointless suffering. It also strongly suggests that the first modern humans were morally primitive. This science seems to discredit Christianity's common meta-narrative of the Fall, understood as a story of Paradise Lost. The author contends (...) that this Augustinian story and its character of Adam as endowed with superhuman gifts, and yet as so fragile as to fall, as claimed, is implausible, at any rate, even apart from science. He proposes that Christians consider adopting a Supralapsarian metaphysics of divine purpose supported by the intuitions of Irenaeus, who depicted the first human beings as comparable to innocent, but morally undeveloped children. In this approach the existence of evils is part of the divine plan to "defeat" them in and through the Incarnation, Atonement, and Resurrection of Christ. Putting an "Irenaean Adam" in place of the "Augustinian" counterpart may not remove conflict with science completely, but at least reduces it, and leads to a Christian narrative that is more plausible, in the light of science. (shrink)

This paper situates the subprime crisis in the context of the performance of the American economy over the last twenty-five years. The restructuring of the US economy is briefly reviewed, followed by an examination of some of the contradictions of the neoliberal model. Particular emphasis is placed on understanding the reasons behind stagnant investment, and how the US finance-led accumulation-régime has become dependent upon, and threatened by, credit-creation delinked from the financing of fixed-capital formation. I argue that while the defeat (...) of the remnants of the New-Deal/Civil-Rights liberal-democratic coalition has provided the political context for the bold re-assertion of the prerogatives of capitalist owners, the neoliberal model has not provided a path out of problems of stagnation and growing debt-dependency that presently plague the US economy. Further, I argue that evidence suggests that the post-1982 restoration of profitability that underpinned the relative improvement of US economic performance has peaked, and that compelling historical and theoretical reasons exist to expect that the profit-rate will decline in the coming decade. This will introduce additional stresses on the current debt-structure of the US economy, triggering a period of prolonged crisis and economic dislocation. The conclusion is that the US economy faces the spectre of a protracted crisis associated with the reassertion of the falling rate of profit. (shrink)

After 40 years of attributing high rates of physician career dissatisfaction, attrition, alcoholism, divorce and suicide to ‘burnout’, there is growing recognition that these outcomes may instead be caused by moral injury. This has led to a debate about the relative diagnostic merits of these two terms, a recognition that interventions designed to treat burnout may be ineffective, and much perplexity about how—if at all—this changes anything. The current research seeks to develop the construct of moral injury outside (...) military contexts, generate more robust validity tests and more fully describe and measure the experiences of persons exposed to moral harms. Absent from the literature is a mechanism through which to move from the collective moral injury experience of physicians to a systematic change in the structure of medical practice. To address this, after providing a brief history, definitions and contrasts between burnout, moral distress and moral injury, we review the interplay of moral and ethical codes in the context of moral injury. We conclude by suggesting that professional associations can potentially prevent moral injury by providing protections for physicians within their codes of ethics. There are no data in this work. (shrink)

Rates of firearm injury and mortality are far higher in the United States compared to other high-income nations. Patterns of firearm injury have complex causal pathways; different social contexts may be differentially affected by firearm legislation. In the context of the diversity of social, political, and legal approaches at the state level, we suggest the application of the social ecological model as a conceptual public health framework to guide future policy interventions in the U.S.

No doubt this breezily written and informative volume will fill a gaping lacuna in most JSE readers' knowledge of evidence for psychokinesis generally and poltergeist phenomena in particular. It certainly did for me. Healy and Cropper survey 52 different Australian cases, spanning the years 1845-2002. The first eleven chapters cover the authors' 11 strongest cases in considerable detail. Chapter 12 describes the remaining 41 cases more briefly, and catalogues all 52 cases in chronological order. Chapter 13 purports to wrap things (...) up, but it's followed by three appendices introducing additional cases outside Australia and brief discussions of similar or at least potentially relevant physical mysteries-for example, some Asian fire poltergeist cases, ball lightning, UFOs, and reported rains of fishes. The authors rate their cases on a five-star scale, which they apply judiciously. Ratings begin at zero for apparent or proven hoaxes, and then range from half a star ("for questionable or very poorly documented cases" [p. 7]) to five stars. Healy and Cropper write: "With only two exceptions, we have reserved the four and five-star rating for very well documented cases where we were able to interview the eyewitnesses or in which we had some other personal involvement" (p. 7). The case they consider the strongest-the Mayanup case from 1955-2002-is the only one to earn five stars. Humpty Doo (1998)-possibly the most famous, or notorious-gets four and a half. Several cases earned between three and four stars, and quite a few get either zero stars or half a star. The two highest-rated cases are genuinely interesting. In the Humpty Doo case, many credible observers witnessed the phenomena under conditions which quite clearly seemed to rule out chicanery, and which conformed to poltergeist reports in other parts of the world. The phenomena included "showers of stones both indoors and out, dangerous objects thrown with great force but without causing injury, objects falling unnaturally slowly yet producing unnaturally loud sounds on impact, objects observed levitating, objects observed materializing in mid-air" (p. 48), the intense heat of apported objects, and more. (shrink)

BackgroundResistance training can offer beneficial physiological and psychological effects. The regular continuation of this exercise can be accomplished by improving the recovery and mood after a workout. Frequency-specific microcurrent might offer a solution here as it has been shown to improve physical injuries, mood state, and sleep. However, knowledge is lacking about the impact of microstimulation after RT on said parameters. The present study aimed to test the effects of RT and muscle-microstimulation on mood and physical recovery in healthy men (...) after performing conventional deadlifts, which is a type of RT.MethodsThe study was conducted according to a single-blind, randomized, placebo-controlled, and two-way crossover study. Twenty participants naïve to microstimulation engaged in RT twice on separate days. They were randomized to receive MS on 1 day and no microstimulation on another day. Before and after the workout and after their treatment, participants self-rated their mood state and mental and physical exhaustion levels.ResultsFindings showed that MS increased the self-ratings of well-rested and sociable and, most importantly, reduced the feeling of exercise-induced exhaustion. There were no MS effects on ratings of feeling sad, happy, or exhausted, although the workout, independent of MS, negatively influenced the level of exhaustion.ConclusionThe combination of enhanced sociableness, reduced fatigue, and exercise-induced exhaustion after a workout, followed by microstimulation, has important implications for professional sporters and nonprofessionals who try to get the best result after a workout. Future studies using a double-blind approach including different types of exercises, different durations of programs, and both sexes can shed more light on the full potential of microstimulation after a workout on mood state and exercise-induced exhaustion. (shrink)

Suicide is a public health problem which will require an integrated cross-sector approach to help reduce prevalence rates. One strategy is to include the legal system in a more integrated way with suicide prevention efforts. Caine explored a public health approach to suicide prevention, depicting risk factors across the socio-ecological model. The purpose of this paper is to examine laws that impact suicide prevention at the individual, relational, community, and societal levels. These levels are fluid, and some interventions will (...) class='Hi'>fall between two, such as a community-level approach to training that enhances provider-patient relationships. At the individual level, we will review laws to improve screening requirements across systems. At the relational level, we note interventions with couples having conflict, such as protection orders and access to attorney consultations, which have been known to be injury prevention mechanisms. At the community level, we discuss legislation that recommends suicide prevention efforts for key individuals working as frontline providers in the medical and educational systems. At the societal level, we explore public awareness campaigns that target stigma reduction for those suffering from mental health burden and enhance linkage to care. The article closes with the discussion that laws are good, but their implementation is essential. (shrink)

Moral judgments can occur either in settings that call for impartiality or in settings that allow for partiality. How effective are impartiality settings such as hospitals in suppressing personal biases? Portrayed as decision-makers in an emergency department, 431 college students made judgments on which of two victims of a mass shooting should receive immediate, life-saving care. Patients differed in ways that could reveal biases, e.g., age, kinship, gender, and villain/hero. Participants rated each patient’s moral deservingness to receive immediate care and (...) the likelihood they would choose the patient. Both scales showed young favored over old, cousin over stranger, and policeman over shooter. In a hospital-room scenario with high risk of injury from falling, age bias disappeared. With moderate fall risk, age bias reversed and kinship deservingness bias disappeared. Bias decreases when there is a decrease in severity of potential harm to the preferred stakeholder. Settings that call for impartiality are not reliable “boundary conditions” against expressions of bias. In the absence of explicit guidelines for allocating scarce resources, a systematic, objective method of random selection offers a potentially useful strategy. (shrink)

Although clinical understandings of self-injury, the deliberate mutilation of body tissue, have developed significantly since the phenomenon was first studied, the predominant stereotype of who self-injures is still White, teenage girls.1 White girls as well as White women are, indeed, at risk for SI, and sociocultural explanations appealing to oppressive socialization—particularly the influence of Western beauty norms—have been offered to explain their high rates of SI. Yet evidence exists to challenge this conception that SI is exclusively a White, female (...) issue: Black women, South... (shrink)

In Sin Sick, Joshua Pederson draws on the latest research about identifying and treating the pain of perpetration to advance and deploy a literary theory of moral injury that addresses fictional representations of the mental anguish of those who have injured or killed others. Pederson's work foregrounds moral injury, a recent psychological concept distinct from trauma that is used to describe the psychic wounds suffered by those who breach their own deeply held ethical principles. Complementing writings on trauma (...) theory that posit the textual manifestation of trauma as absence, Sin Sick draws argues that moral injury appears in literature in a variety of forms of excess. Pederson closely reads works by Dostoevsky (Crime and Punishment), Camus (The Fall), and veterans of the wars in Iraq and Afghanistan (Brian Turner's Here, Bullet; Kevin Powers' The Yellow Birds; Phil Klay's Redeployment; and Roy Scranton's War Porn), contending that recognizing and understanding the suffering of perpetrators, without condoning their crimes, enriches the experience of reading—and of being human. (shrink)

CONCERN ABOUT THE WELL-BEING OF FAMILIES HAS BEEN A CONSTANT refrain in the history of the United States. Change in family forms often has been regarded as a breakdown of the family and a harbinger of social decay. In each historical period, a family form has been identified as an ideal in contrast to which other forms of family have been found deficient, even dysfunctional. Social policies have been designed to reward "good" families and discourage "bad" ones. Today, the increase (...) in single-mother families, the high divorce rate, and the percentage of children living in poverty often are cited as evidence of the breakdown of the family and abandonment of family values because of a culture of "inordinate individualism." The Marriage Movement particularly represents this view. In this essay I first describe this approach to family values, its use of social science to support its claims, and the influence of this perspective on certain liberal Christian proposals for family ideals. I argue that family ideals assume race, gender, and economic privileges that are not available to all. By ignoring socioeconomic realities for many people, these ideals may mask and reinforce unjust inequalities. In fact, the themes and policies of the defense-of-marriage movement fit nicely with the neoliberal political economy that developed in the second half of the twentieth century. I argue that church and social policies that value families must connect the well-being of all families with a commitment to gender equality and economic justice. (shrink)

Persons who experience severe brain injury often suffer significant disorders of consciousness. Anoxic injuries from cardiac arrest or strokes and traumatic injuries from falls, vehicular crashes, or assaults can result in several conditions in which patients lose or have diminished consciousness for an extended period of time. Two such conditions that create considerable public confusion and controversy are the vegetative state and the minimally conscious state. Although these conditions have generated significant medical and academic research, the general public and (...) policymakers are often confused about the nature of VS and MCS. The most recent evidence for this confusion is the acrimonious public debate, the extensive media coverage, the prolonged litigation, and the attempts of various governmental officials to intervene in dealing with the plight of Terri Schiavo. (shrink)

Background: Mild traumatic brain injury results from an external force to the head or body causing neurophysiological changes within the brain. The number and severity of symptoms can vary, with some individuals experiencing rapid recovery, and others having persistent symptoms for months to years, impacting their quality of life. Current rehabilitation is limited in its ability to treat persistent symptoms and novel approaches are being sought to improve outcomes following mTBI. Neuromodulation is one technique used to encourage adaptive neuroplasticity (...) within the brain.Objective: To systematically review the literature on the efficacy of neuromodulation in the mTBI population.Method: A systematic review was conducted using Medline, Embase, PsycINFO, PsycARTICLES and EBM Review. Preferred Reporting Items for Systematic Reviews and the Synthesis Without Meta-analysis reporting guidelines were used and a narrative review of the selected studies was completed. Fourteen articles fulfilled the inclusion criteria which were published in English, investigating an adult sample and using a pre- and post-intervention design. Studies were excluded if they included non-mild TBI severities, pediatric or older adult populations.Results: Thirteen of fourteen studies reported positive reductions in mTBI symptomatology following neuromodulation. Specifically, improvements were reported in post-concussion symptom ratings, headaches, dizziness, depression, anxiety, sleep disturbance, general disability, cognition, return to work and quality of life. Normalization of working memory activation patterns, vestibular field potentials, hemodynamics of the dorsolateral prefrontal cortex and excessive delta wave activity were also seen. The studies reviewed had several methodological limitations including small, heterogenous samples and varied intervention protocols, limiting generalisability. Further research is required to understand the context in which neuromodulation may be beneficial.Conclusions: While these positive effects are observed, limitations included unequal representation of neuromodulation modalities in the literature, and lack of literature describing the efficacy of neuromodulation on the development or duration of persistent mTBI symptoms. Better clarity regarding neuromodulation efficacy could have a significant impact on mTBI patients, researchers, clinicians, and policy makers, facilitating a more productive post-mTBI population. Despite the limitations, the literature indicates that neuromodulation warrants further investigation. PROSPERO registration number: CRD42020161279. (shrink)

Abner Shimony called it coherence; John Kemeny called it strict fairness; today many people speak of strict coherence. According to Shimony's definition, a set of betting rates on a series of propositions hi and ei is strictly incoherent, when “there exists a choice of stakes Si such that, if X accepts the series of bets at these stakes, then no matter what the actual truth values of hi, and ei may be, X can at best lose nothing, and in at (...) least one possible eventuality he will suffer a positive loss”. (shrink)

Until recently, the problem of traumatic brain injury in sports and the problem of performance enhancement via hormone replacement have not been seen as related issues. However, recent evidence suggests that these two problems may actually interact in complex and previously underappreciated ways. A body of recent research has shown that traumatic brain injuries, at all ranges of severity, have a negative effect upon pituitary function, which results in diminished levels of several endogenous hormones, such as growth hormone and (...) gonadotropin. This is a cause for concern for many popular sports that have high rates of concussion, a mild form of TBI. Emerging research suggests that hormone replacement therapy is an effective treatment for TBI-related hormone deficiency. However, many athletic organizations ban or severely limit the use of hormone replacing substances because many athletes seek to use them solely for the purposes of performance enhancement. Nevertheless, in the light of the research linking traumatic brain injury to hypopituitarism, this paper argues that athletic organizations’ policies and attitudes towards hormone replacement therapy should change. We defend two claims. First, because of the connection between TBI and pituitary function, it is likely many more athletes than previously acknowledged suffer from hormone deficiency and thus could benefit from hormone replacement therapy. Second, athletes’ hormone levels should be tested more rigorously and frequently with an emphasis on monitoring TBI and TBI-related issues, rather than simply monitoring policy violations. (shrink)

Firearm injuries are a significant public health problem. Prior studies have analyzed firearm death data or adult firearm injury data, but few studies have analyzed firearm injury data specifically among youth. To inform the current debate surrounding gun policy in the United States, this study aims to provide an estimate of the immense burden of youth firearm injury and its associated risk factors. Therefore, we performed a descriptive analysis of the Nationwide Emergency Department Sample, the largest all-payer (...) emergency department database in the United States, from January 2006 to September 2015. All patients age < 21 who presented with any diagnosis of firearm-related injuries were included. There were an estimated 198,839 incidents of firearm-related emergency department visits for patients age < 21 from 2006 through 2015. After presenting to the ED, an estimated 11,909 cases resulted in death. The population adjusted rate of firearm-related emergency department visits was highest in the South and Midwest. This study demonstrates the significant burden of firearm injury among youth. Having a reliable estimate of the number of children harmed by firearms each year is a critical tool for policymakers — and may make common-sense gun safety measures more politically possible. (shrink)

Injuries in professional soccer are a significant concern for teams, and they are caused amongst others by high training load. This cohort study describes the relationship between workload parameters and the occurrence of non-contact injuries, during weeks with high and low workload in professional soccer players throughout the season. Twenty-one professional soccer players aged 28.3 ± 3.9 yrs. who competed in the Iranian Persian Gulf Pro League participated in this 48-week study. The external load was monitored using global positioning system (...) and the type of injury was documented daily by the team's medical staff. Odds ratio and relative risk were calculated for non-contact injuries for high- and low-load weeks according to acute, chronic, acute to chronic workload ratio, and AW variation values. By using Poisson distribution, the interval between previous and new injuries were estimated. Overall, 12 non-contact injuries occurred during high load and 9 during low load weeks. Based on the variables ACWR and Δ-AW, there was a significantly increased risk of sustaining non-contact injuries during high-load weeks for ACWR, and Δ-AW. Finally, the expected time between injuries was significantly shorter in high load weeks for ACWR [1.25 vs. 3.33, rate ratio time ] and Δ-AW respectively, compared to low load weeks. The risk of sustaining injuries was significantly larger during high workload weeks for ACWR, and Δ-AW compared with low workload weeks. The observed high OR in high load weeks indicate that there is a significant relationship between workload and occurrence of non-contact injuries. The predicted time to new injuries is shorter in high load weeks compared to low load weeks. Therefore, the frequency of injuries is higher during high load weeks for ACWR and Δ-AW. ACWR and Δ-AW appear to be good indicators for estimating the injury risk, and the time interval between injuries. (shrink)

ObjectiveThis study aims to investigate anxiety and its influencing factors in patients with drug-induced liver injury (DILI).Materials and MethodsNinety-four patients with DILI were enrolled and evaluated with a self-rating anxiety scale (SAS). According to the anxiety score, they were divided into four groups: the non-anxiety, mild anxiety, moderate anxiety, or severe anxiety groups, and the scores were analyzed based on demographic and biochemical indicators.ResultsOf the 94 patients with DILI, 63 did not have anxiety and 31 had anxiety (32.9%), of (...) which 27 had mild, 3 had moderate, and 1 had severe anxiety. There were no statistically significant differences in gender, age, occupation, and level of education between the groups (F= 1.42,H= 2.361,H= 6.751,H= 1.796, andP> 0.05); anxiety score and degree of anxiety between the types of drugs that led to the liver injury (H= 0.812,H= 1.712, andP> 0.05); anxiety score between the different degrees of liver injury (H= 2.836,H= 4.957,P> 0.05); or length of hospital stay or prognosis between the degrees of anxiety (F= 1.487,H= 0.761,P> 0.05). However, there were statistically significant differences in the degree of anxiety between different degree and types of liver injury (H= 7.981,H= 8.208,P< 0.05).ConclusionPatients with DILI may have anxiety, especially mild anxiety. The occurrence of anxiety in patients with DILI is not related to gender, age, occupation, or level of education but may be related to the degree and type of liver injury. Anxiety has no impact on the length of stay in hospital or the prognosis of the DILI. These findings may contribute to the development of management strategies for patients with DILI. (shrink)

Traumatic brain injuries to the frontal lobes are associated with many maladaptive forms of behavior. We investigated the association between brain damage and impulsivity, as measured by the rate of delay discounting. The main aim of this study was to test the hypothesis of steeper discounting of different amounts in a group of patients with frontal lobe damage. We used a delay discounting task in the form of a structured interview. A total of 117 participants were divided into five (...) groups: three neurological groups and two groups without brain damage. Our analyses showed that patients with focal damage to the frontal lobes demonstrated steeper delay discounting than other participants. Other clinical groups demonstrated similar discounting rates. The data pattern related to the magnitude effect on the group level suggested that the magnitude effect is absent in the group of patients with damage to the frontal lobes; however, results were less consistent on an individual level. Amount-dependent discounting was observed in only two groups, the healthy control group and the neurological group with other cortical areas damaged. (shrink)

Motor training to improve walking and balance function is a common aspect of rehabilitation following motor-incomplete spinal cord injury. Evidence suggests that moderate- to high-intensity exercise facilitates neuroplastic mechanisms that support motor skill acquisition and learning. Furthermore, enhancing corticospinal drive via transcranial direct current stimulation may augment the effects of motor training. In this pilot study, we investigated whether a brief moderate-intensity locomotor-related motor skill training circuit, with and without tDCS, improved walking and balance outcomes in persons with MISCI. (...) In addition, we examined potential differences between within-day and between-day effects of MST. Twenty-six adults with chronic MISCI, who had some walking ability, were enrolled in a 5-day double-blind, randomized study with a 3-day intervention period. Participants were assigned to an intensive locomotor MST circuit and concurrent application of either sham tDCS or active tDCS. The primary outcome was overground walking speed measured during the 10-meter walk test. Secondary outcomes included spatiotemporal gait characteristics, peak trailing limb angle, intralimb coordination, the Berg Balance Scale, and the Falls Efficacy Scale-International questionnaire. Analyses revealed a significant effect of the MST circuit, with improvements in walking speed, cadence, bilateral stride length, stronger limb TLA, weaker limb ACC, BBS, and FES-I observed in both the MST+tDCSsham and MST+tDCS groups. No differences in outcomes were observed between groups. Between-day change accounted for a greater percentage of the overall change in walking outcomes. In persons with MISCI, brief intensive MST involving a circuit of ballistic, cyclic locomotor-related skill activities improved walking outcomes, and selected strength and balance outcomes; however, concurrent application of tDCS did not further enhance the effects of MST.Clinical Trial Registration[ClinicalTrials.gov], identifier [NCT03237234]. (shrink)

Patient report of functioning is one component of the neurocognitive exam following traumatic brain injury, and standardized patient-reported outcomes measures are useful to track outcomes during rehabilitation. The Traumatic Brain Injury Quality of Life measurement system is a TBI-specific extension of the PROMIS and Neuro-QoL measurement systems that includes 20 item banks across physical, emotional, social, and cognitive domains. Previous research has evaluated the responsiveness of the TBI-QOL measures in community-dwelling individuals and found clinically important change over a (...) 6-month assessment interval in a sample of individuals who were on average 5 years post-injury. In the present study, we report on the responsiveness of the TBI-QOL Cognition–General Concerns and Executive Function item bank scores and the Cognitive Health Composite scores in a recently injured sample over a 1-year study period. Data from 128 participants with complicated mild, moderate, or severe TBI within the previous 6 months were evaluated. The majority of the sample was male, white, and non-Hispanic. The participants were 18–92 years of age and were first evaluated from 0 to 5 months post-injury. Eighty participants completed the 1-year follow-up assessment. Results show acceptable standard response mean values for all measures and minimal detectable change values ranging from 8.2 to 8.8 T-score points for Cognition–General Concerns and Executive Functioning measures. Anchor rating analysis revealed that changes in scores on the Executive Function item bank and the Cognitive Health Composite were meaningfully associated with participant-reported changes in the areas of attention, multitasking, and memory. Evaluation of change score differences by a variety of clinical indicators demonstrated a small but significant difference in the three TBI-QOL change scores by TBI injury severity grouping. These results support the responsiveness of the TBI-QOL cognition measures in newly injured individuals and provides information on the minimal important differences for the TBI-QOL cognition measures, which can be used for score interpretation by clinicians and researchers seeking patient-reported outcome measures of self-reported cognitive QOL after TBI. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.1 (2003) 29-31 [Access article in PDF] On the Border:Reflections on the Meaning of Self-Injury in Borderline Personality Disorder Robert L. Woolfolk Keywords borderline personality disorder, values, psychotherapy, diagnosis IT IS A PLEASURE to comment on Nancy Potter's elegantly written, provocative paper. Professor Potter raises important and intriguing issues that have not only clinical implications for practitioners, but also are of theoretical significance for (...) those who ponder the conceptual status of mental illnesses and their manifestations.Borderline personality disorder (BPD) is the mental health professional's bête noire. In the diagnostic context, borderline is an adjective that is evocative, albeit imprecise. Persons with BPD tend to the worst of multiple pathological worlds, to fall through the diagnostic cracks, to occupy the boundaries of decorum and safety. Even such intrepid and astute folk as Marsha Linnehan and Otto Kernberg, who have devoted careers to understanding and treating those with BPD, have acknowledged the limited state of current knowledge. Justice Stewart's theory of natural concepts seems to apply to patients to whom we give the label borderline personality disorder: we cannot define the disorder readily, but we know one when we see one. And when we see such a patient it is costly in time and stress and corrosive of one's sense of professional efficacy. So with these patients, any assistance in conceptualizing the problem or in modification of therapeutics is welcome.Professor Potter's phenomenological formulation of self-injury is cogent and helpful in a number of ways. Self-injurious behavior is, when conventionally interpreted, a prototype for irrationality and affliction. It is also dramatic, graphic, and often repugnant. Professor Potter's analysis brings us face to face with what most of us know but sometimes forget or fail to apply: Psychotherapy is a value-laden endeavor. Early on, both Max Weber and Carl Jung were eloquent on this point and we have been reminded often enough of it in the last four decades (Rieff 1966; Woolfolk 1998; Woolfolk and Murphy, in press). Usually it is the moral values residing in the underlying ideologies of treatment and diagnosis that are brought to our attention. The axiological underpinnings of psychotherapy, however, are aesthetic as well as ethical. Professor Potter successfully argues that, as therapists, we may be in the thrall of a parochial aesthetic that produces [End Page 29] a kind of tunnel vision inimical to therapeutic effectiveness and to the ethical treatment of the human beings who are our patients. She has impeccable advice for therapists on this topic: Although none of us can step outside of culture altogether, we can evaluate our attitudes, beliefs, and values from a second-order level (Taylor 1989; Frankfurt 1971). Complete objectivity is an unlikely ideal. But clinicians can, and should, think critically about ways in which prevailing norms and values may be influencing their understanding of the world and their ways of being in it. (Potter 2003, 11) Professor Potter also quite effectively persuades that a comprehensive understanding of disorders that occur mostly in women (e.g., somatization disorder) must effectively comprehend feminist scholarship and the sociocultural realities of gender. The concept of the commodification of the female body has been informative in both the epidemiology and treatment of yet another woman's disorder, anorexia nervosa. And although the linkages of somatic commodification to self-injurious behavior may not appear to be so straightforward, the paper points the way to deeper and possibly richer explanations of phenomena that seem at first glance to be inexplicable.The introduction of the concept of uptake into clinical contexts is also a valuable contribution. Those of us familiar with the traditions of psychotherapy recognize a concept both familiar and central. Uptake has family resemblance to the empathic attitude so extensively discussed by both Rogers and Kohut. Those with hermeneutic leanings will recognize affinities with Verstehen and the Gadamerian anticipation of completeness (Vorgriff der Vollkommenheit). Any truly humanistic approach to treatment or diagnosis must encompass the lived experience of the patient. This is not to... (shrink)

IntroductionIn highly developed countries, as many as 16 percent of children are physically abused each year. Traumatic brain injury (TBI) is the most common injury in non-accidental trauma (NAT) and is responsible for 80 percent of fatal NAT cases, with most deaths occurring in children younger than three years old. Cases of abusers who refuse withdrawal of life-sustaining medical treatment (LSMT) to avoid criminal charges have previously been reported. Therefore, we hypothesized that NAT is associated with a lower (...) risk for withdrawal LSMT in pediatric TBI.MethodsThe pediatric Trauma Quality Improvement Program database was analyzed (2014 to 2016) for patients aged 16 and younger with TBI and Glasgow Coma Scale (GCS) of 8 and lower on admission. Patients with a head Abbreviated Injury Scale (AIS) of 2 or less or who died within 48 hours were excluded. A multivariable logistic regression model was used for analysis.ResultsOf 2,209 TBI patients, 92 (4.2 percent) had withdrawal of LSMT. Compared to those without withdrawal of LMST, those with LMST had statistically similar median age (three years of age versus seven years, p = 0.07) and a higher rate of NAT (33.7 percent versus 13.5 percent, p < 0.001). The most common specified perpetrator was a father/stepfather/ male partner (70 percent). After adjusting for covariates, factors associated with higher risk for withdrawal of LSMT included age of less than three years (OR 2.38, CI 1.34-4.23, p < 0.05) and NAT (OR 1.86, CI 1.02-3.41, p < 0.05).ConclusionNAT is associated with increased risk for withdrawal of LSMT in pediatric TBI. Age of less than three years is similarly associated with a higher risk for withdrawal of LSMT. Future research in this population is needed to determine what other factors predict withdrawal of LSMT and what resources, such as social workers and/or ethics consults, are utilized. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Disability Embodied: Narrative Exploration of the Lives of Two Brothers Living with Traumatic Brain InjuryDouglas E. KiddAny discussion of personal experiences with disability, inevitably lead me to recall the experiences of my brother, Richard Kidd. An examination of our journeys clearly illustrates the term disability. More so, our stories reveal the outcome of severe physical impairment dictates the limits of personal agency and autonomy. Perhaps an obvious conclusion, but (...) exploration of our experience is useful as we provide living testimony to eventualities that could similarly occur to others. In order to provide context for discussion of our disabilities, I will briefly recall how we acquired our traumatic brain injuries (TBI), as well as how our brain injuries are expressed. The article will demonstrate that due to the severity of the brain damage he acquired, Richard is entirely subject to the whim of the society he encounters, and thus disabled. The article will also discuss how the disabling attitudes I have encountered sought to diminish my humanity.Richard KiddRichard’s descent into impairment began in the early evening hours of December 31, 1987. As a pedestrian, Richard attempted to cross a street in Indianapolis, when a car without using headlights, slammed into him. In addition, the driver fled the scene of the accident. After stabilizing from the initial trauma—multiple compound fractures to both legs and severe brain injury—Richard spent approximately ten months in coma. After emerging from coma, Richard underwent months of therapy. Albeit with consistent direction from others, therapy enhanced Richard’s ability to hold a cup and use a spoon. These were significant victories for Richard and signaled the beginning of his recovery. However, within two years of his accident, monies ended for rehabilitation and Richard entered into custodial care at his first nursing facility. As time passed, his daily interactions with poorly supervised, unskilled, and underpaid nursing facility employees with little time to work with Richard meant it was more cost efficient for staff to simply spoon–feed Richard. Consequently, Richard lost the ability to participate in an aspect of his self–care. Richard’s humanity took years to gradually erode, but due to the severity of his impairments, he became viewed by those he encountered as an object of treatment, or reservoir of pain and pity, rather than an individual worthy of respect. Accordingly, [End Page 199] Richard became viewed as other. Thus began Richard’s descent into disability.A complete lack of dental care for decades provides a good example of Richard’s treatment as other. Richard’s experience also demonstrates that desensitized members of the medical, dental, and long–term care professions sometimes precipitate grave circumstances. The combination of an inattention to his needs and his limited ability to participate with his self–care meant that Richard typically went without dental treatment. His quality of life diminished further when aides at a nursing facility dropped him. During the fall, Richard’s face smashed into the floor and several teeth were shattered. More than a decade passed before Richard finally received follow–up dental treatment—that day nearly cost him his life. Due to prolonged neglect, all of Richard’s teeth required extraction. I do not question the dental surgeon’s assessment of Richard’s teeth. I am certain that all of his teeth needed to be removed; but Richard’s sedentary lifestyle meant that he had limited ability to cope with the trauma associated with having 24 teeth removed in one session. I feel certain the dental surgeon assumed Richard was like most other patients and could handle the stress associated with the procedures. However, Richard could not cope with trauma and blood loss the extractions produced. What is worse than the dental surgeon’s assessment of Richard’s ability to withstand surgery is the post–op personnel decision to discharge him to home, shortly after surgery. The nursing facility was ill–equipped to cope with the extent of the blood loss that ensued and soon Richard began to aspirate on his own blood. Accordingly, Richard was sent to the hospital where he proceeded to slip into coma. Richard remained in a coma for approximately four days and in hospital... (shrink)

This is an observational exploratory study assessing self-concept and its association with depression, anxiety, satisfaction with life, and quality of life 6 months after experiencing a traumatic brain injury. Participants were 33 patients who suffered a traumatic brain injury 6 months before the assessment. The measures used in this study were the Repertory Grid Technique, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Satisfaction With Life Scale, and the Quality of Life after Brain Injury. We calculated Euclidean distances to (...) assess differences in pre-and post-injury self-perception, as well as the proportion of opposed pole construct rating and polarization to understand how they are associated with the scores of the other offered measures. We found that the distance between the present and ideal self, as well as the distance between the present self and the self before the lesion showed moderate positive correlations with depression, and negative correlations with satisfaction with life and quality of life. Also, for the present and self before the lesion, the proportion of opposed pole ratings was correlated with depression symptoms, quality, and satisfaction with life, while for the present self and the ideal self this proportion was correlated with all the measures. The proportion of polarization of the present self and the total polarization was negatively correlated with symptom measures. The repertory grid might facilitate a greater understanding of self-concept after traumatic brain injury. This information could be used to guide treatments that address the emotions related to distances observed in the perception of the self. (shrink)

Background: Multiple studies have shown that people who have experienced a serious health problem such as an injury tend to overrate the quality of health they had before that event. The main objective of this study was to test whether the phenomenon of respondents overrating their past health can also be observed in people from the general population. A second aim was to test whether habitual optimism is indeed focused on events in the future.Method: A representatively selected community sample (...) from Leipzig, Germany was examined. Respondents were asked to assess their current health, their past health, and their expected future health on a 0–100 scale. In addition, the study participants completed several questionnaires on specific aspects of physical and mental health.Results: Respondents of all age groups assessed their health as having been better in the past than it was at present. Moreover, they also assessed their earlier state of health more positively than people 5 years younger did their current state. Habitual optimism was associated with respondents having more positive expectations of how healthy they will be in 5 years time, but the correlation with their assessments of their current health was nearly as high.Conclusion: Highly positive scores of retrospectively assessed health among people who have experienced a health problem cannot totally be accounted for by a response to that health problem. (shrink)

This nation’s obesity epidemic is hardly a laughing matter. Approximately 300,000 Americans die from obesity-related causes each year, and without corrective measures, obesity may soon be responsible for as many deaths as cigarette smoking. Sixty-one percent of adults are overweight or obese, and the cost of obesity for the year 2000 was estimated to be 117 billion dollars.In Pelman v. McDmalds, a case decided in September 2003, a federal judge dismissed an amended complaint that attempted to hold McDonalds liable for (...) its customers’ obesity-related illnesses. While many argue that such litigation is frivolous and that the plaintiffs did not deserve direct compensation for their injuries, the debate has largely overlooked the important question raised by these cases - who should pay for the enormous financial strain that obesity places on America’s health care system? Although the courtroom may not be the appropriate forum to deal with this issue, the litigation has undoubtedly brought a great deal of much-needed attention to a vexatious social problem. (shrink)

This nation’s obesity epidemic is hardly a laughing matter. Approximately 300,000 Americans die from obesity-related causes each year, and without corrective measures, obesity may soon be responsible for as many deaths as cigarette smoking. Sixty-one percent of adults are overweight or obese, and the cost of obesity for the year 2000 was estimated to be 117 billion dollars.In Pelman v. McDmalds, a case decided in September 2003, a federal judge dismissed an amended complaint that attempted to hold McDonalds liable for (...) its customers’ obesity-related illnesses. While many argue that such litigation is frivolous and that the plaintiffs did not deserve direct compensation for their injuries, the debate has largely overlooked the important question raised by these cases - who should pay for the enormous financial strain that obesity places on America’s health care system? Although the courtroom may not be the appropriate forum to deal with this issue, the litigation has undoubtedly brought a great deal of much-needed attention to a vexatious social problem. (shrink)

There is widespread concern among public health and emergency response officials that there could be a shortage of health care providers in a public health emergency. At least the following three factors could cause an inadequate supply of physicians, nurses, and other health care providers: the severity of the emergency might greatly increase the demand for health services and outstrip the available supply; health care providers might become unavailable because of their own high rates of illness, as was the case (...) in the SARS epidemic; and many health care providers might not report for duty for personal, family, or professional reasons.One way of addressing the shortage is to encourage health care providers from unaffected areas or parts of the country to volunteer their services. A variety of measures have been enacted to facilitate the use of such volunteers. (shrink)

Does the most common response given by participants presented with Tversky and Kahneman’s famous taxi cab problem amount to a violation of Bayes’ theorem? In other words, do they fall victim to so-called base-rate fallacy? In the present paper, following an earlier suggestion by Crupi and Girotto, we will identify the logical arguments underlying both the original diagnosis of irrationality in this reasoning task under uncertainty and a number of objections that have been raised against such a diagnosis. (...) This will enable us to show firstly that, contrary to the dismissive arguments recently put forward by Elqayam and Evans, empirical evidence turns out to be quite useful in addressing questions of this kind. Therefore, it can make a significant contribution to moving the base-rate fallacy controversy forward. Secondly, the available empirical evidence (though limited and sometimes inconclusive) seems to support the charge of irrationality levelled against the majority of participants presented with the taxi cab problem, and hence suggests that base-rate neglect is a real fallacy − that is the conclusion of our analysis. (shrink)